ショウカキ ガン ノ カガク リョウホウチュウ ニ ショウジタ pinch-off syndrome ノ 3ショウレイ

Recently Implanted central venous catheter ports（CV ports）are more commonly used inpatients with cancer when long-term venous access is needed for the administration of chemotherapy,antibiotics and nutritional support. Pinch-off syndrome occurs when chronic compressionforces between the clavicle and the first rib. We report three patients with pinch-off syndrome.Case 1 : Two months after placement, the chest radiograph showed grade 2 pinch-off sign. Case 2 :Two months after placement, the chest CT showed complete transection of the catheter at thelevel of the clavicle. The distal fragment was in the hepatic vein, the inferior vena cava and theright atrium. Case 3 : A palpable mass was noticed below the right clavicle when the port wasaccessed. The chest radiograph showed grade 2 pinch-off sign. Removing the catheter, it wasfractured. The distal fragment was in the superior vena cava. Six months after replacement,complete transection of the catheter was occurred. The distal fragment was in the right ventricle.All this distal fragment of the catheter could be retrieved percutaneously with a transvenous snare.Pinch-off syndrome is the potential for serious complication, we study how to prevent pinch-offsyndrome

スイトウ ジュウニシチョウ セツジョ オ オコナッタ カン スイ ジュウニシチョウ シンジュン, ナイロウ ケイセイ ケッチョウ ガン

In spite of approach with hepatic flexure of the colon and Ⅱ nd portion of the duodenum, theevent of colo-duodenal fistula due to colon cancer is rare. We report a case of colo-duodenal fistuladue to colon cancer, invade with liver, pancreas and duodenum, 62-year-old female with severeanemia. She underwent right hemicolectomy with pancreatoduodenectomy and partial hepatectomy.On postoperative 2 years, the recurrence of the solitary lymphnode-metastasis was appearedon the left-side cervix

テンイソウ デ ホルモン ジュヨウタイ ノ ヘンイ オ ミトメタ ニュウガン ノ 1レイ

A 44 year old woman visited the hospital with complaint of the right breast tumor which she left for two years. She presented with a large mass of８．５cm in diameter with skin invasion, right axillar lymph nodes, multiple liver, and bone metastases. Core needle biopsy of the main tumor revealed an invasive ductal carcinoma（scirrhous carcinoma）with nuclear grade 2 with ER（＋）,PgR（＋）, HER2（－）. The patient was treated with hormone therapy for three and a half year.The extensive mediastinum lymph nodes metastasis and multiple lung metastasis and a new tumor in the right thyroid lobe were appeared. The liver metastasis also increased in size and number.The therapy switched to chemotherapy with paclitaxel. Although the reductive effect was appeared in the breast mass, lung metastasis and liver metastasis, the thyroid and mediastinal lymph node metastases increased in size aggressively. The cytology of needle biopsy specimen from the thyroid tumor was consistent with breast cancer metastasis. Histopathology of the biopsy specimens from the mediastinal lymph node and the liver metastases also consist with breast cancer metastases, but ER and PgR receptor status converted to negative in mediastinal lymph nodes

ジュツゼン シンダンシエタ タンノウ ネンテンショウ ノ 1レイ

We report on a case of torsion of the gallbladder, whitch was correctly diagnosed preoperatively using pre-operative imaging with ultrasound and computed tomography. A 88-year-old woman was admitted to the hospital because of diarrhea and fever. Increased levels of WBC, CRP were noted in laboratory test. An Abdominal ultrasound showed a swollen gallbladder with a thicked wall in the body and funds, floating gallbladder and a high echo level lesion with an acoustic shadow in the gallbladder. Abdominal computed tomography showed a gallbladder with a spirally twisted neck and small gass lesion. Diagnostic imaging demonstrated acute inflammatory changes in the gallbladder with an abnormal arrangement of the gallbladder. These results suggested necrotizing cholecystitis with tortion of the gallbladder. During the operation, the gallbladder was found to be enlarged and twisted 360 degrees in a clockwise direction at the neck of the gallbladder, resulting in gangrenous change. A cholecystectomy was successfully performed and the patient was discharged in good condition, 23 days after the operation

A case report of secretory carcinoma of the breast in elderly

A 67-year-old woman was seen at the hospital because of a tumor in the area of the right breast. On physical examination, the tumor was elastic hard and movable. A core needlebiopsy revealed malignant findings' invasive ductal carcinoma. Mastectomy for right breast was performed. Pathological diagnosis was secretory carcinoma. The immunoprofile data were negative for ER, PR, and HER2, and were positive for the S-100, EMA, Adipophilin. She has been free from recurrence and metastasis so far. Secretory breast carcinomas are rare tumors, low-grade triple-negative carcinomas. Distant metastases from secretory breast carcinomas and local recurrence are extremely rare. Standard treatment has not been deciderd yet. We report a case of secretory carcinoma of the breast together with some bibliographical comments

チョメイナ カンガイ ハツイク オ シメシタ カンケッカンシュ ノ 1レイ

Giant hemangiomas of the liver with the diameter of more then 10 cm are likely to grow rapidly with bleeding in tumor and concur a terrible complication such as heavy bleeding caused by tumor rupture. We experienced a case of giant hemangioma of the liver with a pronounced extrahepatic growth. A 33-year-old woman consulted a doctor because of common cold and was pointed out having hepatomegaly. She was admitted to the hospital for further examination. Abdominal ultrasonography showed a heterogenous high echoic tumor with even surface lying ventral to the gallbladder from the margin inferior hepatis. Abdominal CT scan showed a low density tumor which growed from S4, 5 and 6 of the liver to extrahepatic area. The tumor was confirmed to show low intensity on T1-weighted images and remarkable high intensity on T2-weighted images on a magneticresonance imaging scan and had strong contract effect from the edge by a contract medium. It showed cotton wool like appearance on an angiography. It was diagnosed as hemangioma of the liver and a partial hepatic resection was conducted. The resected tumor was rubiginous, spongy, 11×5.5×7.5 cm in size and 660g in weight. Histopathologically, it was diagnosed as cavernous hemangioma

センコウセイ フクマクエン デ ハッショウ シタ ショウチョウ gastrointestinal stromal tumor ノ 1レイ

We report a case of gastrointestinal stromal tumor (GIST) with perforation in the jejunum and peritoneal dissemination. A 64 year-old man admitted our hospital with severe abdominal pain. He had findings of panperitonitis and the abdominal CT examination revealed free air and an intraabdominal abscess. We suspected perforation of the small intestine and operated. There were two adjacent tumors (6cm in diameter each) of the jejunum and peritoneal dissemination, and one of them was perforated. We performed a jejunojejunostomy and resected as all disseminated tumors as possible. Histopathological findings showed that the tumors were composed of spindle cell proliferation with three or four mitoses per high-power fields (HPF). Because tumor cell were positive for c-kit and CD34, and negative for alpha-smooth muscle actin and S-100 immunohistochemically, we diagnosed these tumors as “maligmant GIST of small intestine, uncommitted type”. Perforation of GIST is rare. Only 20 cases of GIST with peritonitis due to perforation have been reported in Japan, including the present case. Of 20 cases, 14 were small intestinal GIST. Small intestinal GIST should be recognized as a high-risk group of malignancy and perforation

A case of the gastric metastasis from invasive lobular carcinoma of the breast

A 45-year-old woman underwent total mastectomy with axillary lymph node dissection for right breast cancer in 2015. Histopathological examination of the resected specimen showed triple-negative invasive lobular carcinoma and advanced lymph node metastasis. The patient underwent postoperative adjuvant therapy consisting of a dose-dense epirubicin-cyclophosphamide regimen and weekly paclitaxel and radiotherapy. However, multiple bone metastases were detected, 18 months postoperatively. The patient developed upper abdominal discomfort, 21 months postoperatively, and gastroscopy revealed multiple, irregular depressed lesions in the stomach. Histopathological examination of stomach biopsy specimens revealed tumor cells that showed diffuse invasion of the lamina propria of mucous membrane. Immunohistochemical evaluation of biopsy specimens obtained from the stomach and the excised breast tissue showed cells that were immunopositive for CK7 and GCDFP-15 and immunonegative for CK20. The gastric lesion was therefore diagnosed as metastases from invasive lobular carcinoma of the breast. Although the patient received chemotherapy, she died of meningeal carcinomatosis from breast cancer, 7 month after the diagnosis of stomach metastasis. Immunohistochemical evaluation for CK20, which is expressed in gastric cancer and GCDFP-15, which originates from breast tissue, is useful to distinguish between breast cancer metastases and signet ring cell carcinoma of the stomach

No-touch pylorus-resecting pancreatoduodenectomy can reduce postoperative complications even in low volume center

Purposes : Pancreatoduodenectomy (PD) was performed for 6 periampullary cancer patients by using methods verified by quality randomized controlled trials (RCT) in a low-volume center (LVC). The purpose of this study was to verify the clinical results. Methods : No-touch pylorus-resecting pancreatoduodenectomy (PrPD), antecolic gastrojejunostomy, pancreatico-jejunostomy with a lost stent tube to the main pancreatic duct, and early removal of a prophylactic drain were performed. Results : The drain could be removed 4 days after operation, and no pancreatic fistula was observed in all cases. Solid food could be started on POD4 after removing the drain. Furthermore, postoperative systemic chemotherapy could be started earlier. Conclusion : Although we have only a few PD cases a year in our institution, PD can be conducted safely without complications by using the methods verified by quality RCTs

Outcome of emergency one-stage resection and anastomosis procedure for patients with obstructed colorectal cancer

Purposes : The purpose of this study was to verify the outcome of the emergency one stage resection and anastomosis procedure for patients with obstructed colorectal cancer. Methods : An emergency one stage resection and anastomosis procedure was performed for 40 patients with obstructive colorectal cancer. The outcome was verified and compared dividing into two groups. 17 patients under the age of 70 in (Group A), 23 patients 70 years and over in (Group B). Results : The operative mortality rate in both groups was 0%. As a result, postoperative complications were not significantly different between the two groups. The overall survival rate after a 5-year period in both groups was 41.8%, regarding all patients and the survival curves for the two groups, was not significantly different. The 5 year survival rate in stage II or III showed no differences between the two groups. Conclusion : The one-stage resection and anastomosis of the large bowel could be applied safely to emergency patients, which in turn allows for excellent shortterm operative results in both groups mentioned. This particular procedure should be positively enforced, even in elderly patients in their 70’s